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 Table of content page
introduction 1

 Why cancer is an important subject in our life?

 What is cancer?
 What is the differences between Cancer Cells and Normal
Cells?
 How Cancer Arises?
 What are "Drivers" of Cancer?
 When Cancer Spreads?
 How Cancer Spreads.
 Tissue Changes that Are Not Cancer.
 Types of Cancer.
 Why cancer is an important subject in our life?
 This is some points that show us the importance of cancer and these are facts
about this killer disease:
• Cancer is the second leading cause of death globally, and is
responsible for an estimated 9.6 million deaths in 2018. Globally, about 1 in 6
deaths is due to cancer.
• Approximately 70% of deaths from cancer occur in low- and middle-
income countries.
• Around one third of deaths from cancer are due to the 5 leading
behavioral and dietary risks: high body mass index, low fruit and vegetable
intake, lack of physical activity, tobacco use, and alcohol use.
• Tobacco use is the most important risk factor for cancer and is
responsible for approximately 22% of cancer deaths.
• Cancer causing infections, such as hepatitis and human papilloma virus
(HPV), are responsible for up to 25% of cancer cases in low- and middle-
income countries.
• Late-stage presentation and inaccessible diagnosis and treatment are
common. In 2018, only 26% of low-income countries reported having
pathology services generally available in the public sector. More than 90% of
high-income countries reported treatment services are available compared to
less than 30% of low-income countries.
• The economic impact of cancer is significant and is increasing. The total
annual economic cost of cancer in 2018 was estimated at approximately US$
1.16 trillion.
• Only 1 in 5 low- and middle-income countries have the necessary data
to drive cancer policy.
 What is cancer?
Cancer is the name given to a collection of related diseases. In all types of
cancer, some of the body’s cells begin to divide without stopping and spread
into surrounding tissues.

Cancer can start almost anywhere in the human body, which is made up of
trillions of cells. Normally, human cells grow and divide to form new cells as the
body needs them. When cells grow old or become damaged, they die, and
new cells take their place.

When cancer develops, however, this orderly process breaks down. As cells
become more and more abnormal, old or damaged cells survive when they
should die, and new cells form when they are not needed. These extra cells
can divide without stopping and may form growths called tumors.

Many cancers form solid tumors, which are masses of tissue. Cancers of the
blood, such as leukemias, generally do not form solid tumors.

Cancerous tumors are malignant, which means they can spread into, or
invade, nearby tissues. In addition, as these tumors grow, some cancer cells
can break off and travel to distant places in the body through the blood or the
lymph system and form new tumors far from the original tumor.

Unlike malignant tumors, benign tumors do not spread into, or invade, nearby
tissues. Benign tumors can sometimes be quite large, however. When
removed, they usually don’t grow back, whereas malignant tumors sometimes
do. Unlike most benign tumors elsewhere in the body, benign brain tumors can
be life threatening.
 What is the differences between Cancer Cells and Normal
Cells?
Cancer cells differ from normal cells in many ways that allow them to grow out
of control and become invasive. One important difference is that cancer cells
are less specialized than normal cells. That is, whereas normal cells mature
into very distinct cell types with specific functions, cancer cells do not. This is
one reason that, unlike normal cells, cancer cells continue to divide without
stopping.

In addition, cancer cells are able to ignore signals that normally tell cells to
stop dividing or that begin a process known as programmed cell death, or
apoptosis, which the body uses to get rid of unneeded cells.

Cancer cells may be able to influence the normal cells, molecules, and blood
vessels that surround and feed a tumor (tumor is an area known as the
microenvironment). For instance, cancer cells can induce nearby normal cells
to form blood vessels that supply tumors with oxygen and nutrients, which they
need to grow. These blood vessels also remove waste products from tumors.

Cancer cells are also often able to evade the immune system, a network of
organs, tissues, and specialized cells that protects the body from infections
and other conditions. Although the immune system normally removes
damaged or abnormal cells from the body, some cancer cells are able to “hide”
from the immune system.

Tumors can also use the immune system to stay alive and grow. For example,
with the help of certain immune system cells that normally prevent a
runaway immune response, cancer cells can actually keep the immune system
from killing cancer cells.
 How Cancer Arises?

Cancer is a genetic disease that is, it is caused by changes to genes that

control the way our cells function, especially how they grow and divide.

Genetic changes that cause cancer can be inherited from our parents. They
can also arise during a person’s lifetime as a result of errors that occur as cells
divide or because of damage to DNA caused by certain environmental
exposures. Cancer-causing environmental exposures include substances,
such as the chemicals in tobacco smoke, and radiation, such as ultraviolet rays
from the sun. (Our Cancer Causes and Prevention section has more
information).

Each person’s cancer has a unique combination of genetic changes. As the

cancer continues to grow, additional changes will occur. Even within the same
tumor, different cells may have different genetic changes.

In general, cancer cells have more genetic changes, such as mutations in

DNA, than normal cells. Some of these changes may have nothing to do with
the cancer; they may be the result of the cancer, rather than its cause.
Cancer is caused by certain changes to genes, the basic physical units of
inheritance. Genes are arranged in long strands of tightly packed DNA called
chromosomes.
Credit: Terese Winslow
 What are "Drivers" of Cancer?
The genetic changes that contribute to cancer tend to affect three main types
of genes: (proto-oncogenes, tumor suppressor genes, and DNA repair genes).
These changes are sometimes called “drivers” of cancer.

Proto-oncogenes are involved in normal cell growth and division. However,

when these genes are altered in certain ways or are more active than normal,
they may become cancer-causing genes (or oncogenes), allowing cells to
grow and survive when they should not.

Tumor suppressor genes are also involved in controlling cell growth and
division. Cells with certain alterations in tumor suppressor genes may divide in
an uncontrolled manner.

DNA repair genes are involved in fixing damaged DNA. Cells with mutations in
these genes tend to develop additional mutations in other genes. Together,
these mutations may cause the cells to become cancerous.

As scientists have learned more about the molecular changes that lead to
cancer, they have found that certain mutations commonly occur in many types
of cancer. Because of this, cancers are sometimes characterized by the types
of genetic alterations that are believed to be driving them, not just by where
they develop in the body and how the cancer cells look under the microscope.
 When Cancer Spreads?

A cancer that has spread from the place where it first started to another place
in the body is called metastatic cancer. The process by which cancer cells
spread to other parts of the body is called metastasis.

Metastatic cancer has the same name and the same type of cancer cells as
the original, or primary, cancer. For example, breast cancer that spreads to
and forms a metastatic tumor in the lung is metastatic breast cancer, not lung
cancer.

Under a microscope, metastatic cancer cells generally look the same as cells
of the original cancer. Moreover, metastatic cancer cells and cells of the
original cancer usually have some molecular features in common, such as the
presence of specific chromosome changes.

Treatment may help prolong the lives of some people with metastatic cancer.
In general, though, the primary goal of treatments for metastatic cancer is to
control the growth of the cancer or to relieve symptoms caused by it.
Metastatic tumors can cause severe damage to how the body functions, and
most people who die of cancer die of metastatic disease.  
In metastasis, cancer cells break away from where they first formed (primary
cancer), travel through the blood or lymph system, and form new tumors
(metastatic tumors) in other parts of the body. The metastatic tumor is the
same type of cancer as the primary tumor.
 How Cancer Spreads?

 Primary and secondary cancer.

 How cancer can spread to other areas of the body .
 Spread through the blood circulation .

 Spread through the lymphatic system.

 Primary and secondary cancer

The place where a cancer starts in the body is called the primary cancer or
primary site. Cells from the primary site may break away and spread to other
parts of the body. These escaped cells can then grow and form other tumours,
which are known as secondary cancers or metastases.

 How cancer can spread to other areas of the body?

Cancer cells can spread to other parts of the body through the bloodstream or
lymphatic system. There they can start to grow into new tumours.
Cancers are named according to where they first started developing. For
example, if you have bowel cancer that has spread to the liver, it's called bowel
cancer with liver metastases or secondaries. It is not called liver cancer. This is
because the cancerous cells in the liver are actually cancerous bowel cells.
They are not liver cells that have become cancerous.
In order to spread, some cells from the primary cancer must break away, travel
to another part of the body and start growing there. Cancer cells don't stick
together as well as normal cells do. They may also produce substances that
stimulate them to move. 

The diagram below shows a tumour in the cells lining a body structure such as
the bowel wall. The tumour grows through the layer holding the cells in place
(the basement membrane). Some cells can break away and go into small
lymph vessels or blood vessels called capillaries in the area.

 Spread through the blood circulation

When the cancer cells go into small blood vessels they can then get
into the bloodstream. They are called circulating tumour cells (or CTCs).

Researchers are currently looking at using circulating tumour cells

to diagnose cancer and avoid the need for tests such as biopsies. They
are also looking at whether they can test circulating cancer cells to
predict which treatments will work better. 

The circulating blood sweeps the cancer cells along until they get stuck

somewhere. Usually they get stuck in a very small blood vessel such as
a capillary.

diagram showing a cancer cell stuck in a small blood vessel capillary.

 Then the cancer cell must move through the wall of the capillary and into
the tissue of the organ close by. The cell can multiply to form a new
tumour if the conditions are right for it to grow and it has the nutrients
that it needs.

diagram showing how cancer cells get into the bloodstream .

https://www.cancer.gov/about-cancer/understanding/what-is-cancer
This is quite a complicated process and most cancer cells don't survive
it. Probably, out of many thousands of cancer cells that reach the
bloodstream, only a few will survive to form a secondary cancer.
Some cancer cells are probably killed off by the white blood cells in our
immune system. Others cancer cells may die because they get battered
around by the fast flowing blood.

Cancer cells in the circulation may try to stick to platelets to form clumps
to give themselves some protection. Platelets are blood cells that help
the blood to clot. This may also help the cancer cells to move into the
surrounding tissues.

 Spread through the lymphatic system

The lymphatic system is a network of tubes and glands in the body
that filters body fluid and fights infection. It also traps damaged or
harmful cells such as cancer cells. 
Cancer cells can go into the small lymph vessels close to the primary
tumour and travel into nearby lymph glands. In the lymph glands, the
cancer cells may be destroyed but some may survive and grow to form
tumours in one or more lymph nodes. Doctors call this lymph node
spread.


 Tissue Changes that Are Not Cancer

Not every change in the body’s tissues is cancer. Some tissue changes may
develop into cancer if they are not treated, however. Here are some examples
of tissue changes that are not cancer but, in some cases, are monitored:

Hyperplasia occurs when cells within a tissue divide faster than normal and
extra cells build up, or proliferate. However, the cells and the way the tissue is
organized look normal under a microscope. Hyperplasia can be caused by
several factors or conditions, including chronic irritation.

Dysplasia is a more serious condition than hyperplasia. In dysplasia, there is

also a buildup of extra cells. But the cells look abnormal and there are changes
in how the tissue is organized. In general, the more abnormal the cells and
tissue look, the greater the chance that cancer will form.

Some types of dysplasia may need to be monitored or treated. An example of

dysplasia is an abnormal mole (called a dysplastic nevus) that forms on the
skin. A dysplastic nevus can turn into melanoma, although most do not.

An even more serious condition is carcinoma in situ. Although it is sometimes

called cancer, carcinoma in situ is not cancer because the abnormal cells do
not spread beyond the original tissue. That is, they do not invade nearby tissue
the way that cancer cells do. But, because some carcinomas in situ may
become cancer, they are usually treated.
Normal cells may become cancer cells. Before cancer cells form in tissues of
the body, the cells go through abnormal changes called hyperplasia and
dysplasia. In hyperplasia, there is an increase in the number of cells in an
organ or tissue that appear normal under a microscope. In dysplasia, the cells
look abnormal under a microscope but are not cancer. Hyperplasia and
dysplasia may or may not become cancer.
Credit: Terese Winslow https://www.cancer.gov/about-
cancer/understanding/what-is-cancer
 Types of Cancer
There are many types of cancer but these are the most popular types:
 Lung cancer.
 Kidney Cancer.
 Leukemia.
 Liver.
 Thyroid Cancer.
 Melanoma (skin cancer).
 Pancreatic Cancer.
 Breast Cancer.
 Bladder Cancer.
 Prostate Cancer.
 Lung cancer
Lung cancer is when abnormal cells divide in an uncontrolled way to form a
tumour in the lung.The main symptoms are a cough, breathlessness and weight
loss. The treatment you need depends on what type you have as well as your
general health. Treatments include surgery, chemotherapy and radiotherapy.

What are the risk factors?

The causes of lung cancer are not fully understood, and some people develop
lung cancer without having any known risk factors. The factors listed below are
known to increase the risk of developing the disease.
 Smoking tobacco
 Chemicals and workplace risks
 Air pollution
 Previous lung disease
 Exposure to radon gas
 Family history of lung cancer
 Previous radiotherapy treatment
 kidney cancer

The kidneys are made up of different types of cells. The type of cancer you have
depends on the type of cell the cancer starts in.

The most common type of kidney cancer is renal cell cancer. It starts in
the cells lining the tubules (the smallest tubes) inside the nephrons.

What are the risk factors?

  Body weight and height
  Smoking
  Kidney disease
  Faulty genes and inherited conditions
  Family history
  High blood pressure
  Alcohol
  Thyroid cancer
  Diabetes
  Radiotherapy for cancer
  Hysterectomy
  Mild painkillers
 Leukaemia
Leukaemia is cancer of blood-forming cells. Leukaemia usually causes large
numbers of white blood cells to be made.
These abnormal cells usually can't carry out the normal functions of white blood
cells. They crowd the bone marrow and spill into the blood and may then spread
into organs such as the liver, spleen, lungs and kidneys. Sometimes, they may
also spread into the fluid around the brain and spinal cord.
Because there are so many abnormal white cells crowded into the bone marrow,
the marrow sometimes can't make enough normal red blood cells, white blood
cells and platelets.

Risks and causes

 Smoking
 Being overweight
 Exposure to benzene
 Genetic reason
 Family history
 Liver
Primary liver cancer is a malignant tumour that starts in the liver. The main type
of primary liver cancer that can affect adults is hepatocellular carcinoma (HCC).
HCC starts in the hepatocytes, the liver's main cell type, and is also known as
hepatoma. This section focuses on HCC.
A less common type of liver cancer can start in the bile ducts that connect the
liver to the bowel and gall bladder. This is known as cholangiocarcinoma or bile
duct cancer.
A very rare type of liver cancer that starts in the blood vessels is known as
angiosarcoma. Hepatoblastoma is a form of liver cancer that affects only young
children and is also very rare.

The risk factors for liver cancer

 Smoking
 Body weight
 Alcohol
 Diabetes
 Family history

Thyroid cancer
Thyroid cancer is type of cancer that affects the thyroid gland, a small gland at
the base of the neck.

The most common symptom of cancer of the thyroid is a painless lump or

swelling that develops in the neck.

Risks and causes

 Radiation
 Genetic reason
 Family history
 Melanoma (skin cancer)

Melanoma is a type of skin cancer that can spread to other organs in the body.

The most common sign of melanoma is the appearance of a new mole or a

change in an existing mole. This can happen anywhere on the body, but the
back, legs, arms and face are most commonly affected.

In most cases, melanomas have an irregular shape and more than one colour.
They may also be larger than normal moles and can sometimes be itchy or bleed.

Risks and causes of melanoma

 Age.
 Ultraviolet light.
 A lot of sun exposure.

Pancreatic cancer
Pancreatic cancer arises when cells in the pancreas, a glandular organ
behind the stomach, begin to multiply out of control and form a mass.
These cancerous cells have the ability to invade other parts of the body.

Risk factors
 Tobacco smoking.
 Obesity.
 Diabetes.
 Certain rare genetic condition.

Diagnostic method
 Medical imaging.
 Blood tests.
 Tissue biopsy.
Prevention
 Not smoking.
 Maintaining a healthy weight.
 Low red meat diet.

Treatment
 Surgery.
 Radiotherapy.
 Chemotherapy.
 Palliative care.